Neuroblastoma symptoms in children — signs every parent should recognise

The most frequently noticed sign is a firm, painless lump or swelling in the belly — sometimes described by parents as the abdomen feeling hard or looking bloated. Because neuroblastoma usually starts in the adrenal gland (above the kidney) or along the sympathetic nerve chain in the abdomen, a palpable abdominal mass is the first clue in many cases. Other common neuroblastoma signs include unexplained bone pain (especially in the legs or back), general irritability in a very young child, persistent tiredness, reduced appetite, and weight loss. In some children the first visible sign is around the eyes: the tumour can spread to the orbit and cause bruising or swelling around both eyes — a pattern called raccoon eyes or periorbital ecchymosis. No single symptom confirms a diagnosis; a doctor's examination and imaging are always needed.

Parents and caregivers most often notice the lump during bathing or nappy changing — it feels firm rather than soft, sits deep in the belly, and does not usually cause pain when touched gently. The abdomen may look visibly swollen or one side may appear fuller than the other. Unlike an enlarged spleen or liver (which also produce abdominal fullness), a neuroblastoma mass is often irregular in shape and may cross the midline if it is large. Any firm, unexplained abdominal swelling in a young child — particularly under five years of age — warrants a same-week appointment with a paediatrician rather than a wait-and-see approach.

Yes. Neuroblastoma can affect the eyes in two distinct ways. First, if the tumour spreads to the bony socket around the eye (the orbit), it can cause purple or bruised-looking swelling around one or both eyes — this is called periorbital ecchymosis, or raccoon eyes, and it is one of the more striking and recognisable signs of neuroblastoma spread. It is not caused by trauma. Second, if the tumour grows near the nerve chain in the neck or upper chest, it can press on a set of nerves that control the eye and face, producing Horner syndrome: a drooping eyelid, a smaller pupil, and reduced sweating on that side of the face. Either finding in a young child should be evaluated urgently.

Neuroblastoma can spread to the bones and bone marrow. When cancer cells infiltrate bone, they can cause pain — often aching rather than sharp, and often worse at night or after rest. Bone pain from neuroblastoma is commonly felt in the legs, back, or skull. Parents may notice their child limping without a clear injury, refusing to walk, or waking at night in discomfort. In infants, the only sign may be persistent crying or unusual irritability. If bone pain in a young child persists for more than a week or two without an obvious explanation such as a fall, it is worth discussing with a doctor. See our related page on child bone pain at night for more guidance.

Neuroblastoma is predominantly a cancer of very young children. The majority of cases are diagnosed before a child's fifth birthday, and a significant proportion occur in infancy — some even before birth, detected on prenatal ultrasound as an adrenal mass. It is rare after the age of ten. This is why any firm abdominal lump or unexplained constitutional symptoms such as persistent irritability, poor feeding, or unexplained weight loss in a child under five deserve prompt medical attention. Early-stage neuroblastoma, when found before it has spread widely, generally responds better to treatment — making early evaluation important.

Once a doctor suspects neuroblastoma based on symptoms and physical examination, investigation typically involves an ultrasound of the abdomen first — this is quick, painless, and shows the size and position of any mass. From there, an MRI or CT scan gives more detailed anatomical information, and an MIBG scan (a nuclear medicine test specific to neuroblastoma) maps whether the tumour has spread to bones or distant sites. Blood and urine tests checking for catecholamine breakdown products (homovanillic acid and vanillylmandelic acid) support the diagnosis. A biopsy of the tumour is usually required to confirm the diagnosis definitively. At CION, every paediatric case is reviewed by a full tumour board — medical, surgical, and radiation oncologists together — before any treatment plan is finalised and presented to the family.